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Quizzes > Health & Medicine

Chest X Ray Quiz: Practice Interpretation on Realistic Cases

Quick, free CXR quiz to test your knowledge. Instant results.

Editorial: Review CompletedCreated By: Dr Dipti ShresthaUpdated Aug 24, 2025
Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art chest x-ray quiz illustration on dark blue background featuring stylized lungs, ribs, magnifying glass.

This chest x ray quiz helps you practice reading thoracic images, recognize normal and abnormal patterns, and get instant feedback on each case. Brush up on structure with the chest anatomy quiz, expand your prep with a radiology practice test, or review related care in a med surg respiratory quiz.

Which cardiac chamber forms the right border of the heart on a standard posteroanterior chest x-ray?
Left ventricle
Left atrium
Right ventricle
Right atrium
On a PA chest radiograph, the right atrial silhouette forms the right heart border. The right ventricle contributes to the anterior border but not the rightmost border, while the left chambers lie on the opposite side. Recognizing these anatomical silhouettes is essential for localizing pathology. .
What is the name of the angle where the diaphragm meets the chest wall on a chest x-ray?
Hilar angle
Azygous fissure
Costophrenic angle
Cardiophrenic angle
The costophrenic angles are formed by the junction of the diaphragm and the chest wall and should appear sharp on a normal chest x-ray. Blunting of this angle often indicates pleural effusion. The cardiophrenic angle is between the heart border and the diaphragm. .
Which feature is most reliable for assessing patient rotation on a PA chest radiograph?
Medial ends of the clavicles equidistant from spinous processes
Cardiac silhouette shape
Scapular position over the lung fields
Symmetry of the diaphragm
Rotation is best judged by the clavicles: on a true PA film, the medial ends of both clavicles are equidistant from the spinous processes of the thoracic spine. Diaphragm symmetry and scapular position are less reliable. Proper rotation is essential to avoid misinterpretation of mediastinal structures. .
Which organism is the most common cause of lobar pneumonia in adults?
Streptococcus pneumoniae
Mycoplasma pneumoniae
Haemophilus influenzae
Staphylococcus aureus
Streptococcus pneumoniae is the most frequent pathogen in adult lobar pneumonia, classically producing homogeneous consolidation of one or more lobes. Other organisms tend to cause bronchopneumonia or atypical patterns. Early radiographic recognition guides appropriate antibiotic therapy. .
Kerley B lines on a chest x-ray are most indicative of which condition?
Interstitial pulmonary edema
Atelectasis
Pleural thickening
Emphysema
Kerley B lines are short, horizontal lines at the lung periphery representing thickened interlobular septa in interstitial pulmonary edema. They are typically seen at the lung bases near the costophrenic angles. Identifying them can help diagnose early heart failure. .
On a supine chest x-ray, which sign suggests the presence of a pleural effusion?
Deep sulcus sign
Meniscus sign
Air bronchogram
Silhouette sign
The meniscus sign refers to a curvilinear fluid line seen on upright or decubitus films, indicating pleural fluid layering. In supine views, free fluid can still produce a subtle meniscus at the lung periphery. The deep sulcus sign is for pneumothorax, and air bronchograms suggest alveolar consolidation. .
What does the silhouette sign describe in chest radiography?
Shift of mediastinum toward the lesion
Appearance of air within the mediastinum
Elevation of the diaphragm by adjacent mass
Loss of normal border between two anatomical structures in contact
The silhouette sign occurs when two structures of similar radiographic density are in contact, obliterating their border. For example, right middle lobe pneumonia hides the right heart border. It helps localize lesions to specific lung lobes. .
The deep sulcus sign on a supine chest x-ray is most suggestive of:
Pericardial effusion
Pneumothorax
Pleural effusion
Mediastinal emphysema
In a supine patient, air in the pleural space accumulates anteriorly and laterally, deepening the costophrenic angle - this is the deep sulcus sign. It is an important indicator of pneumothorax when upright films cannot be obtained. .
A large left pleural effusion typically shifts the mediastinum:
Not at all
Toward the opposite side
Toward the same side
Cranially
Mass-effect lesions like large pleural effusions push mediastinal structures away from the affected side, so a left effusion shifts the mediastinum to the right. This helps distinguish between space-occupying processes and collapse, which pulls structures toward the lesion. .
The 'spinnaker sail' sign on a neonatal chest x-ray is characteristic of which condition?
Pneumomediastinum
Tension pneumothorax
Congenital diaphragmatic hernia
Pericardial effusion
In neonatal pneumomediastinum, air lifts the thymic lobes apart, creating a sail-like appearance known as the spinnaker sail sign. This radiographic feature is pathognomonic for mediastinal air in infants. Early recognition allows prompt management. .
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Study Outcomes

  1. Identify Anatomical Landmarks -

    Pinpoint key structures such as lung fields, heart borders, and mediastinum to establish a solid foundation for chest x ray quiz interpretation.

  2. Analyze Radiographic Quality -

    Evaluate image factors like penetration, inspiration, and rotation to ensure accurate assessment of chest radiographs.

  3. Assess Cardiac Silhouette -

    Measure and interpret heart size and contours to distinguish normal from abnormal cardiothoracic ratios.

  4. Recognize Common Pathologies -

    Detect findings consistent with pneumonia, pleural effusion, pneumothorax, and other frequent chest xray quiz challenges.

  5. Apply a Systematic Approach -

    Use a step-by-step method (ABCDE) to ensure comprehensive review and avoid overlooked abnormalities.

  6. Interpret Quiz Feedback -

    Analyze your chest radiography quiz results to identify strengths, address gaps, and track improvement over time.

Cheat Sheet

  1. Systematic ABCDE Approach -

    Implement the ABCDE mnemonic - Airway, Breathing, Circulation, Diaphragm, Everything else - on every image in your chest x ray quiz. Start by confirming tracheal alignment and evaluating hilar contours, as recommended by Radiopaedia. A fun trick is remembering "All Boys Can Drink Espresso" to lock in the sequence.

  2. Lung Markings and Patterns -

    Differentiate alveolar vs interstitial opacities by their appearance: alveolar shows fluffy, cloud-like densities with air bronchograms, while interstitial presents a reticular or nodular network (RSNA). For instance, bat-wing edema radiates around the hilum in pulmonary edema. Practicing these distinctions in a chest radiography quiz builds rapid pattern recognition.

  3. Cardiothoracic Ratio Calculation -

    Calculate CTR by dividing maximal horizontal heart width by internal thoracic width at diaphragm level; a ratio over 0.5 suggests cardiomegaly (American Heart Association). Example: a 14 cm heart over a 26 cm chest yields 0.54. Use quick mental math drills in each chest xray quiz to hone speed and accuracy.

  4. Diaphragm and Pleural Assessment -

    Check diaphragmatic domes - right should sit 1 - 2 cm above left - and inspect costophrenic angles to exclude effusions per British Thoracic Society guidelines. Free air under the right hemidiaphragm signals pneumoperitoneum, an emergency finding. Testing these in your chest x ray quiz ensures you catch subtle pleural changes.

  5. Key Pathology Identifiers -

    Master the silhouette sign: loss of a border between structures equals adjacent consolidation, e.g., a blurred right heart border in right middle lobe pneumonia (UpToDate). Spot the deep sulcus sign for supine pneumothorax - an abnormally deep lateral costophrenic angle. Integrate these clues into every chest x ray quiz to cement diagnostic recall.

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